St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE T RIGHT 1MM25-301-36

Facility

$2,399.80

Service Code	HCPCS C1713
Hospital Charge Code	64907371
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.90
Max. Negotiated Rate	$1,199.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,199.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,199.90

PLATE T RIGHT 1MM25-301-36

Facility

$2,399.80

Service Code	HCPCS C1713
Hospital Charge Code	64907371
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,519.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,319.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,439.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,199.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,379.88
Rate for Payer: EmblemHealth Commercial	$1,199.90
Rate for Payer: Fidelis Medicare Advantage	$2,519.79
Rate for Payer: Group Health Inc Commercial	$1,199.90
Rate for Payer: Group Health Inc Medicare	$839.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,199.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,199.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,559.87

PLATE, TRINICA 22MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64904189
Hospital Revenue Code	278
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00

PLATE, TRINICA 22MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64904189
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,187.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,964.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,470.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,840.50
Rate for Payer: EmblemHealth Commercial	$2,470.00
Rate for Payer: Fidelis Medicare Advantage	$5,187.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,211.00

PLATE, TRINICA SELECT 24MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64904881
Hospital Revenue Code	278
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00

PLATE, TRINICA SELECT 24MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64904881
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,187.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,964.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,470.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,840.50
Rate for Payer: EmblemHealth Commercial	$2,470.00
Rate for Payer: Fidelis Medicare Advantage	$5,187.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,211.00

PLATE, TRINICA SELECT 40MM

Facility

$5,350.00

Service Code	HCPCS C1713
Hospital Charge Code	64904216
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.00
Max. Negotiated Rate	$2,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,675.00

PLATE, TRINICA SELECT 40MM

Facility

$5,350.00

Service Code	HCPCS C1713
Hospital Charge Code	64904216
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,617.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,942.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,675.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,076.25
Rate for Payer: EmblemHealth Commercial	$2,675.00
Rate for Payer: Fidelis Medicare Advantage	$5,617.50
Rate for Payer: Group Health Inc Commercial	$2,675.00
Rate for Payer: Group Health Inc Medicare	$1,872.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,675.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,477.50

PLATE TROCHANTERIC

Facility

$5,874.75

Service Code	HCPCS C1713
Hospital Charge Code	64901786
Hospital Revenue Code	278
Min. Negotiated Rate	$2,937.38
Max. Negotiated Rate	$2,937.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,937.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,937.38

PLATE TROCHANTERIC

Facility

$5,874.75

Service Code	HCPCS C1713
Hospital Charge Code	64901786
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,168.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,231.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,524.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,937.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,377.98
Rate for Payer: EmblemHealth Commercial	$2,937.38
Rate for Payer: Fidelis Medicare Advantage	$6,168.49
Rate for Payer: Group Health Inc Commercial	$2,937.38
Rate for Payer: Group Health Inc Medicare	$2,056.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,937.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,937.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,818.59

PLATE T TIT 2.0X53MM 2H-HD 8H-SH

Facility

$677.50

Service Code	HCPCS C1713
Hospital Charge Code	64902538
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$711.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$372.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$406.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$338.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$389.56
Rate for Payer: EmblemHealth Commercial	$338.75
Rate for Payer: Fidelis Medicare Advantage	$711.38
Rate for Payer: Group Health Inc Commercial	$338.75
Rate for Payer: Group Health Inc Medicare	$237.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.75
Rate for Payer: Hamaspik Choice Inc Medicare	$338.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$440.38

PLATE T TIT 2.0X53MM 2H-HD 8H-SH

Facility

$677.50

Service Code	HCPCS C1713
Hospital Charge Code	64902538
Hospital Revenue Code	278
Min. Negotiated Rate	$338.75
Max. Negotiated Rate	$338.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.75
Rate for Payer: Hamaspik Choice Inc Medicare	$338.75

PLATE TUBULAR 1/3 10 HOLES

Facility

$121.50

Service Code	HCPCS C1776
Hospital Charge Code	40209446
Hospital Revenue Code	278
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$72.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.86
Rate for Payer: EmblemHealth Commercial	$60.75
Rate for Payer: Fidelis Medicare Advantage	$127.58
Rate for Payer: Group Health Inc Commercial	$60.75
Rate for Payer: Group Health Inc Medicare	$42.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.98

PLATE TUBULAR 1/3 10 HOLES

Facility

$121.50

Service Code	HCPCS C1776
Hospital Charge Code	40209446
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75

PLATE TUBULAR 1/3 11 HOLES

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40201275
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$69.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: EmblemHealth Commercial	$58.00
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

PLATE TUBULAR 1/3 11 HOLES

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40201275
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

PLATE TUBULAR 1/3 6HLS 73MM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209439
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

PLATE TUBULAR 1/3 6HLS 73MM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209439
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

PLATE TUBULAR 1/3 6 HOLES

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	64906222
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

PLATE TUBULAR 1/3 6 HOLES

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	64906222
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$207.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$118.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.85
Rate for Payer: EmblemHealth Commercial	$99.00
Rate for Payer: Fidelis Medicare Advantage	$207.90
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.70

PLATE TUBULAR 1/3 7H 85MM

Facility

$121.50

Service Code	HCPCS C1713
Hospital Charge Code	40209445
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75

PLATE TUBULAR 1/3 7H 85MM

Facility

$121.50

Service Code	HCPCS C1713
Hospital Charge Code	40209445
Hospital Revenue Code	278
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$72.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.86
Rate for Payer: EmblemHealth Commercial	$60.75
Rate for Payer: Fidelis Medicare Advantage	$127.58
Rate for Payer: Group Health Inc Commercial	$60.75
Rate for Payer: Group Health Inc Medicare	$42.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.98

PLATE TUBULAR 1/3 7HLS 85IMM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209440
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

PLATE TUBULAR 1/3 7HLS 85IMM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209440
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

PLATE TUBULAR 1/3 7 HOLES 85MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	64901148
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

Know your out-of-pocket cost for care.

All Charges